Provider Briefing: Fluorometholone Supply Disruptions in 2026

Fluorometholone — one of the most commonly prescribed mild ophthalmic corticosteroids — has been subject to intermittent supply disruptions that are affecting patient access in 2026. For ophthalmologists, optometrists, and primary care providers who prescribe this medication, understanding the scope of the shortage and having a plan for alternatives is essential to maintaining continuity of care.

This article provides a comprehensive overview of the current Fluorometholone supply situation, its clinical implications, and actionable strategies for prescribers.

Timeline: How We Got Here

Fluorometholone supply challenges are not entirely new. The ophthalmic corticosteroid market has experienced periodic disruptions over the past several years, driven by a combination of factors:

• 2022-2023: Broader pharmaceutical supply chain disruptions post-pandemic affected sterile injectable and ophthalmic manufacturing globally
• 2024: Several ophthalmic generic manufacturers consolidated operations, reducing the overall number of production lines dedicated to Fluorometholone formulations
• 2025: Intermittent shortages of Fluorometholone 0.1% suspension were reported, with sporadic availability of the 0.25% suspension (FML Forte) and ointment (FML S.O.P.)
• 2026 (current): Supply remains inconsistent. Multiple formulations — including generic Fluorometholone 0.1%, Flarex (Fluorometholone Acetate), and brand-name FML products — continue to experience intermittent stockouts at the pharmacy level

Prescribing Implications

The Fluorometholone shortage creates several clinical considerations for prescribers:

Patient Non-Adherence Risk

When patients cannot fill their prescribed Fluorometholone, many simply go without treatment rather than contacting their provider. This can lead to undertreated ocular inflammation, delayed healing, and potential complications — particularly in post-operative patients or those with chronic conditions like anterior uveitis.

Formulary and Therapeutic Substitution

Pharmacy-level therapeutic substitution of ophthalmic corticosteroids is generally not permitted without prescriber authorization. This means patients who arrive at the pharmacy and find Fluorometholone unavailable are often turned away unless you've proactively authorized an alternative.

Intraocular Pressure Monitoring

Many providers choose Fluorometholone specifically because of its lower propensity to elevate intraocular pressure (IOP) compared to Prednisolone Acetate or Dexamethasone. If substituting a more potent steroid, additional IOP monitoring may be warranted — particularly in steroid responders, glaucoma suspects, and pediatric patients.

Current Availability Picture

As of early 2026, the following formulations are affected:

Availability varies significantly by region and wholesaler. Pharmacies sourcing from McKesson, Cardinal Health, or AmerisourceBergen may have different stock levels at any given time.

Cost and Access Challenges

Even when Fluorometholone is available, cost can be a barrier for patients:

• Cash price: $100-$155 for generic 0.1% suspension (5 mL) without insurance
• With discount cards: $40-$60 (SingleCare, GoodRx)
• Brand-name FML: $180-$280 per bottle
• Insurance coverage: Generally covered as a generic; brand versions may require prior authorization or step therapy

For a detailed cost breakdown and savings resources for patients, see: How to save money on Fluorometholone in 2026.

Tools and Resources for Providers

Medfinder for Providers

Medfinder for Providers allows you to check real-time pharmacy inventory for Fluorometholone and direct patients to pharmacies that currently have stock. This can be integrated into your workflow to reduce callbacks and improve prescription fill rates.

Proactive Prescribing Strategies

Consider these approaches to minimize disruption for your patients:

1. Write "DAW 0" or allow substitution — permit the pharmacist to dispense any available generic or brand formulation of Fluorometholone
2. Pre-authorize alternatives — include a note on the prescription or in the patient's chart authorizing substitution with Loteprednol Etabonate if Fluorometholone is unavailable
3. Prescribe multiple formulations — if appropriate, write for both the suspension and ointment to give the pharmacy flexibility
4. Communicate with local pharmacies — establishing relationships with pharmacies that reliably stock ophthalmic products can streamline access for your patient panel

Alternative Medications

When Fluorometholone is truly unavailable, the following alternatives should be considered based on clinical indication and patient risk factors:

• Loteprednol Etabonate 0.5% (Lotemax): Closest IOP-risk profile to Fluorometholone. Available as suspension, gel, and ointment. Generic available.
• Prednisolone Acetate 1% (Pred Forte): More potent, widely available, affordable generic. Requires IOP monitoring.
• Dexamethasone 0.1% (Maxidex): Potent; best for short-course use. Widely manufactured.
• Rimexolone 1% (Vexol): Low IOP risk but less widely available.

For provider guidance on helping patients find alternatives, see: How to help your patients find Fluorometholone in stock.

Looking Ahead

The structural factors driving the Fluorometholone shortage — limited manufacturers, sterile production complexity, and supply chain fragility — are unlikely to resolve quickly. Providers should plan for continued intermittent availability through at least mid-2026.

Key actions for your practice:

• Develop a standardized alternative protocol for when Fluorometholone is unavailable
• Educate staff on directing patients to Medfinder for real-time stock checks
• Monitor the FDA Drug Shortage Database for official updates
• Consider patient education handouts about the shortage and what steps patients can take

Final Thoughts

Fluorometholone remains an important medication in ophthalmic care, particularly for patients who need corticosteroid treatment with a lower risk of IOP elevation. While the current supply disruptions are challenging, proactive prescribing strategies, familiarity with alternatives, and tools like Medfinder for Providers can help ensure your patients continue to receive appropriate care.

For the patient-facing version of this update, see: Fluorometholone shortage update for patients.